Performance & compliance

So first off why pharma quality and manufacturing are at odds and why they should be? I need a volunteer. I'm going to ask this volunteer two questions. I'm going to create two scenarios and a Sequoia volunteer to questions could anybody help me out. Louis would you mind okay alright okay alright so. Louis I'd like you to imagine that you are standing standing at the corner of a trolley track. okay and if you look over your right shoulder could you five gentlemen stand up please yeah all five of you if you could stand up please yeah Michael could you stand up also you look over your right shoulder and their five men working on the track. Okay but you also happen to notice here's something you look over your left shoulder and there's a trolley screaming down a hill about to go around the corner a trolley that they can neither see nor hear. And well the results will be very bad for them yeah. However right here like right here is a switch there is a switch and instead of the trolley screaming around the hill you could change the could you stand up ma'am you could change the track so that it only takes out one worker. What are you doing do? you throw this way. "Interesting I Sophie's Choice." yeah you're good I throw this there is no time does one throw the switch I i assume I'd throw the switch alright alright very good sorry gentlemen you could sit down oh oh but you get to stand up over here so this is the other scenario alright so let's imagine we need five more volunteers starting from the back one two three four five could you sir stand up and the rest of you behind him now imagine that we are standing on a footbridge over a trolley track. You look over your right shoulder there is a trolley screaming down the tracks such that it will take out these five workers. It will kill these five workers, However standing next to you on the footbridge is someone who's kind of looking over the edge at the trolley track and you could push onto the trolley track and stop the trolley from taking them out. What are you doing? Do you push her? I don't know what I do there. Do you push her? You're right I don't think I'd do that. it's like a suit you're saying yeah is it that interested her choice but the math is the same. yeah and surely you see the math is the same, but you know what's interesting about this is that universally regardless of age, gender, culture, we almost make the exact same choices everywhere. We humanity almost everywhere makes the exact same choices. Yes, we will throw the switch no, we will not push someone. All right, You may all sit down thank you for your thank you for your help. Now Now, this issue of what is the moral choice is an important choice for us in pharma ,right? And philosophers back to Deming, back to Darwin, and on, have all gotten to the question of well: What makes us make a good choice? In pharmaceuticals and pharmaceutical manufacture there's a particularly important question because we want everyone in our organization to make a good choice. If they don't it all falls apart. And those philosophers from Darwin on back have laid the responsibility for this at the foot of culture. Yeah pharmaceutical culture. For example. and it's our parents, our religious leaders, our CEOs, our senior management that passes down the culture. Yeah. But there's some very interesting research by this professor josh green who lent me this slide from Harvard and what Josh has been doing in addition to asking doing the this tremendous web-based survey to get that statistic on the global response of 98% yes they would throw the switch, and no they would not push someone. Josh has also taken a functional MRI. Which is an MRI the size of a small airplane in order to see the individual cells lighting up as he asks people this exact same trolley dilemma, and he found that, there's actually two different locations in our brain that are responding differently to this moral choice. One appears to be this emotional assessment. No, I will not push someone onto the tracks. I will not kill my kin. Millions of years of on-the-job training to do no harm. Here's to be right here in the amygdala. And something as simple as a lever, is able to short-circuit this moral calculus and arrive at a different moral calculus, that utilitarian assessment of the greater good, for the greatest number. Can you almost see how this might fall into oh yeah, that's what manufacturing is doing? Oh yeah this is what quality assurance and quality control is doing? Oh and that's what my pointer finger and between the two is judgment. So perhaps is possible in other industries, for a brain to parse all of that but in our industry given the risk profile of low volumes, high cost, and high risks, we have evolved a very functional and efficient way of dividing responsibility for these different aspects of morality. Has anyone here ever talked to a Quality assurance or Quality Control director, and the first thing they tell you is listen I don't want to hear how much it costs. I don't want to know anything. I don't want to know any numbers. Doesn't matter. Yeah you see some people shaking their heads yep. I think they're doing the right thing.  I think they're doing the right   thing. I think they're working out of this moral basis of, do no harm. And if something as simple   as a lever can throw that switch and short curcuit that morality, they are taking the   right position, because once I start throwing statistics at them there's very few switches,   very few sticks is powerful as statistics to short-circuit someone's morality, yeah. And arrive at this utilitarian assessment which is what manufacturing is often discussing.